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Hormone Replacement Therapy Q&A

1. Should I stop taking hormone replacement therapy (HRT)?

It depends on how long you’ve been taking it and why. Here are some facts to help you decide:

You may be taking HRT to relieve menopause symptoms. At one time, doctors also used to prescribe HRT to manage diseases like osteoporosis and heart disease in women past menopause. But in 2002, a Women’s Health Initiative study found that women who took the most common form of HRT, a combined estrogen and progesterone pill, had a higher risk of heart disease, stroke, and blood clots.

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HRT and Menopause Symptoms: Research shows that a small dose of HRT is still the best way to reduce uncomfortable symptoms in early menopause. Women younger than 60 have the lowest risks, especially if they use the estrogen-only formula for a short time, applying it to their skin instead of taking by mouth.

Several years of treatment is usually enough to relieve symptoms. So if you’ve been on HRT for more than 5 years, talk with your doctor about tapering off.

HRT and Heart Disease: Doctors no longer prescribe hormones to manage heart disease or other chronic conditions like osteoporosis. If you’re taking HRT to reduce the risk of heart disease, ask your doctor about gradually stopping it.

Before the WHI study, doctors prescribed HRT for heart problems. Some earlier studies  showed that women who took hormones had lower rates of heart disease and other chronic diseases. The women may have just been healthier and had better access to medical care.

The WHI study and follow-ups confirmed that HRT didn’t reduce the risk of heart disease; it increased it in healthy, postmenopausal women.

HRT and Osteoporosis: As with heart disease, you should weigh the benefits of using hormones with other risks. To reduce osteoporosis, doctors often suggest lifestyle changes such as regular weight-bearing exercise. You can also try medicine like Fosamax and Evista, or calcium and vitamin D supplements.

Or you may look at other choices, such as statins, which reduce cholesterol in the blood, but also treat osteoporosis and heart disease.

2. Is any type of hormone therapy safer than others?

Experts are still not sure. You and your doctor should talk about which form of HRT might be right for you.

Low-dose hormone replacement therapy: Studies show that lower doses of hormone replacement therapy offer the same benefits without as many risks. In a new study by the Fred Hutchinson Cancer Research Center, where the WHI research took place, women who took low-dose estrogen had 53% fewer hot flashes and night sweats.

Estrogen alone: This is the suggested treatment for women who’ve had a hysterectomy to remove their uterus. Women who take estrogen alone have fewer risks of breast cancer and other disorders. Still, doctors caution that taking estrogen alone can increase your risk of stroke and uterine cancer.

Bio-identical estrogen patches, creams, or vaginal rings: These forms of estrogen are similar to what the body makes. Unlike a pill, they enter the body through the skin or walls of the vagina. In this way, they bypass the liver, reducing the risk of serious blood clots or gallbladder disease.

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